<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header"></head>
<body class="gray-bg">
	<div class="wrapper wrapper-content animated fadeInRight">
		<div class="row">
			<div class="col-sm-12">
				<div class="ibox float-e-margins">
					<div class="ibox-content">
						<form class="form-horizontal m-t" id="signupForm">
							<input id="producerId" name="producerId" type="hidden">
							<input id="areaCode" name="areaCode" type="hidden">
							<input id="areaName" name="areaName" type="hidden">
							<div class="form-group">
								<label class="col-sm-3 control-label">药品厂家名称：</label>
								<div class="col-sm-8">
									<input id="producerName" name="producerName" class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">法定代表人姓名：</label>
								<div class="col-sm-8">
									<input id="legalPersonName" name="legalPersonName" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">身份证号：</label>
								<div class="col-sm-8">
									<input id="legalPersonId" name="legalPersonId" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">信用代码：</label>
								<div class="col-sm-8">
									<input id="creditCode" name="creditCode" class="form-control"
										type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">注册时间：</label>
								<div class="col-sm-8">
									<input id="regDate" name="regDate" class="form-control"
										type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">注册资金：</label>
								<div class="col-sm-8">
									<input id="regCapital" name="regCapital" class="form-control"
										type="number">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">省：</label>
								<div class="col-sm-8">
									<select class="form-control" name="province" id="Province">
                                    <option> 请选择 </option>
                                    </select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">市：</label>
								<div class="col-sm-8">
									<select class="form-control" name="city" id="City">
                                    <option> 请选择 </option>
                                    </select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">县/区：</label>
								<div class="col-sm-8">
									<select class="form-control" name="village" id="Village">
                                    <option> 请选择 </option>
                                    </select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">电话：</label>
								<div class="col-sm-8">
									<input id="phone" name="phone" class="form-control"
										type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">银行帐号：</label>
								<div class="col-sm-8">
									<input id="account" name="account" class="form-control"
										type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">开户行：</label>
								<div class="col-sm-8">
									<input id="bank" name="bank" class="form-control"
										type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">地址：</label>
								<div class="col-sm-8">
									<input id="address" name="address" class="form-control"
										type="text">
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">备注：</label>
								<div class="col-sm-8">
									<input id="remarks" name="remarks" class="form-control"
										type="text">
								</div>
							</div>
							
							<div class="form-group">
								<input id="content" name="introduction" type="hidden"> <label
									class="col-sm-1 control-label">简介：</label>
								<div class="col-sm-11">
									<div class="ibox-content no-padding">
										<div id="content_sn" class="summernote"></div>
									</div>
								</div>
							</div>
							
							<div class="form-group">
								<label class="col-sm-3 control-label">状态:</label>
								<div class="col-sm-8">
									<label class="radio-inline"> <input type="radio"
										name="flag" value="1" /> 启用
									</label> <label class="radio-inline"> <input type="radio"
										name="flag" value="0" /> 注销
									</label>
								</div>
							</div>
							
							<div class="form-group">
								<div class="col-sm-8 col-sm-offset-3">
									<input id="submit" class="btn btn-primary" name="submit" type="submit" value="提交" >
								</div>
							</div>
						</form>
					</div>
				</div>
			</div>
		</div>

	</div>
	<div th:include="include::footer"></div>
	<script type="text/javascript" src="/js/appjs/drugproducer/drugproducer/add.js">
	</script>
	<script src="/js/plugins/laydate/laydate.js"></script>
</body>
<script>
laydate.render({
	  elem: '#regDate', //指定元素
	  istoday: true,
	  fixed: false,
	  festival: true,
	});
</script>
</html>
